Provider Demographics
NPI:1154898674
Name:HAYES, KENYETTA TREMESE (MSW, ST)
Entity type:Individual
Prefix:MS
First Name:KENYETTA
Middle Name:TREMESE
Last Name:HAYES
Suffix:
Gender:F
Credentials:MSW, ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S WEST ST APT A
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-1701
Mailing Address - Country:US
Mailing Address - Phone:229-821-6000
Mailing Address - Fax:
Practice Address - Street 1:103 S WEST ST APT A
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1701
Practice Address - Country:US
Practice Address - Phone:229-821-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor